Post-Thrombotic Syndrome and Tendinitis After DVT

Post-thrombotic syndrome (venous insufficiency) and tendinitis?

Dear Doctor, four months ago I developed deep vein thrombosis (DVT) in my calf due to tight bandaging from an injury.
After taking anticoagulants, a follow-up ultrasound two weeks later showed no thrombosis.
However, after exercising, I experienced muscle tendonitis (diagnosed via orthopedic ultrasound) in the same calf.
During a follow-up visit, the vascular specialist diagnosed me with post-thrombotic syndrome.
Currently, after walking about 5 minutes each day, my calf becomes increasingly stiff, and the stiffness extends to the front of my thigh in the afternoon.
However, after lying down and elevating my leg for half an hour, it becomes softer, with swelling around 5%.
I have been on anticoagulants for two months now, and I feel stuck between “post-thrombotic syndrome (venous insufficiency)” and “tendinitis.” I am still taking both medications without improvement.
How can I clarify whether my current symptoms are due to post-thrombotic syndrome or tendinitis? Is it possible that the vascular ultrasound missed small vessel thrombosis?

Da A, 40~49 year old female. Ask Date: 2015/10/31

Dr. Hong Ximing reply Orthopedics

For calf vein thrombosis, it is advisable to consult a vascular surgeon, and in severe cases, vascular imaging may be necessary.
Tendonitis typically occurs near the joint area, and you can consult a rehabilitation physician to understand the condition better.

Reply Date: 2015/10/31

More Info

Post-Thrombotic Syndrome (PTS) and tendinitis can present with overlapping symptoms, making it challenging to differentiate between the two conditions, especially after experiencing a Deep Vein Thrombosis (DVT). Understanding the characteristics of each condition is crucial for proper diagnosis and management.

Post-Thrombotic Syndrome (PTS) is a complication that can occur after a DVT. It results from damage to the venous valves and the surrounding tissues due to the thrombus (blood clot) that formed in the deep veins. Symptoms of PTS typically include:
1. Swelling: This is often persistent and may worsen throughout the day, especially after prolonged standing or walking.

2. Pain or heaviness: Patients often describe a feeling of heaviness or aching in the affected limb, which can be exacerbated by activity.

3. Skin changes: Over time, the skin may become discolored, and in some cases, ulcers can develop.

4. Stiffness: As you mentioned, your leg becomes hard after walking, which can be a sign of venous insufficiency associated with PTS.

The symptoms you describe—hardness in the calf after walking, which improves with elevation—are consistent with PTS. The fact that your symptoms improve when you elevate your leg suggests that venous return is impaired, a hallmark of PTS.

Tendinitis, on the other hand, is an inflammation of the tendon, often due to overuse or injury. Symptoms of tendinitis typically include:
1. Localized pain: This pain is usually specific to the tendon and may worsen with movement or activity involving the affected tendon.

2. Swelling: There may be localized swelling around the tendon, but it is not typically associated with the same degree of generalized swelling seen in PTS.

3. Stiffness: Tendinitis can cause stiffness, particularly in the morning or after periods of inactivity, but this stiffness is usually localized to the joint or tendon area.

In your case, the diagnosis of tendinitis was made based on ultrasound findings. However, the symptoms you describe—especially the hardness and swelling that improves with elevation—are more indicative of PTS rather than isolated tendinitis.

Differentiating Between PTS and Tendinitis:
1. Location of Symptoms: PTS symptoms are more diffuse and related to the entire limb, while tendinitis pain is localized to a specific tendon.

2. Response to Activity: PTS symptoms often worsen with prolonged activity and improve with elevation, while tendinitis pain typically worsens with specific movements.

3. Ultrasound Findings: While ultrasound can identify larger clots, it may not always detect smaller clots or subtle changes in venous function. If PTS is suspected, further imaging or functional studies may be warranted.

Management:
- For PTS, treatment options include compression therapy (such as wearing compression stockings), leg elevation, and possibly medications to manage symptoms. Physical therapy may also be beneficial to improve venous return and strengthen the muscles around the affected area.

- For tendinitis, rest, ice, anti-inflammatory medications, and physical therapy focused on stretching and strengthening the affected tendon are typically recommended.

Given your ongoing symptoms and the complexity of your situation, it is essential to maintain open communication with your healthcare providers. They may consider further diagnostic imaging or referrals to specialists, such as a vascular surgeon or a physical therapist, to help clarify your diagnosis and tailor an appropriate treatment plan.
In conclusion, while both PTS and tendinitis can cause discomfort and functional limitations, understanding their distinct characteristics can aid in effective management. If symptoms persist or worsen, further evaluation is warranted to ensure optimal care.

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